Night-Waking

Spontaneous arousal from sleep during the night, common in infants and young children.

Normal Sleep Architecture

All children cycle between light and deep sleep every 60–90 minutes. During light sleep phases, minor disturbances—hunger, discomfort, external noise—can trigger full waking. Newborns wake every 2–3 hours for feeding by biological necessity. By 4–6 months, most infants can physically sustain 8–10 hour stretches without feeding, though many continue waking from habit or inability to self-soothe.

Primary Causes

Hunger (birth–6 months)

• Newborns require 8–12 feeds per 24 hours
• Night feeds typically reduce after 12 weeks as daytime intake increases
• After 6 months, night-waking for hunger often reflects inadequate daytime calories rather than true need

Sleep associations (3+ months)

• Dependency on parent intervention (rocking, feeding, patting) to return to sleep
• Child cannot transition between sleep cycles independently
• Most common cause of persistent night-waking beyond 6 months

Environmental disruptions

• Light (including monitor lights, thermometer displays)
• Temperature extremes
• Noise without white noise masking

Medical causes

• Reflux (peak: 6–16 weeks)
• Teething discomfort
• Sleep apnoea, asthma (see warning signs)
• Pinworms (preschool age)

Developmental factors

• Separation anxiety (8–12 months, 18–24 months)
• Night fears, nightmares (2+ years)
• Sleep regressions during cognitive leaps

Age-Specific Patterns

Night Mode Protocol

Minimise stimulation during all night interactions:

1. Lighting — Complete darkness; no night lights. If essential, use ≤15W red light positioned away from child's face
2. Noise — Maintain loud white noise (50+ dB) throughout night
3. Interaction — No talking, eye contact, or play. Keep feeds/nappy changes brief and mechanical
4. Timing — Wait 2 minutes before responding to allow self-settling attempts

Managing Night Feeds

Reducing frequency (4+ months):

• Increase daytime calorie intake, especially fats
• Gradually decrease volume: reduce by 30ml (1oz) every 2–3 nights
• Delay first feed: if waking before midnight, extend wait time by 15 minutes nightly until reaching 3–4am

After 4am: Minimal intervention zone. Keep child swaddled (if age-appropriate), offer abbreviated feed (60–90ml/2–3oz), no nappy change unless soiled.

After 5am: No-feed zone. Cuddle back to sleep or use scheduled wake time (6–7am) with full light exposure.

Bedtime Timing

Early bedtime paradoxically reduces night-waking. Overtired children produce cortisol, fragmenting sleep.

Bedtime more than 30 minutes later than optimal increases night-waking frequency.

Teaching Independent Sleep

Cannot be addressed during night-waking episodes—must begin at bedtime. Place child in cot/bed wholly awake. Use consistent "SWAP" (Sleep With Assistance Plan):

• Gradual withdrawal of presence over 5–10 nights
• Check-ins at 10+ minute intervals if using cry-based methods
• Stop checks after 4–5 consecutive visits if child remains awake

Resume same approach for night wakings after midnight. Before midnight, allow longer self-settling attempts.

Warning Signs

Consult GP if night-waking accompanied by:

• Loud snoring, breathing pauses, gasping
• Persistent difficulty breathing through nose
• Excessive sweating during sleep
• Frequent Night Terrors (not simple nightmares)
• Perianal itching (possible pinworms)
• Regression after 6+ months of consolidated sleep

Common Errors

• Rushing to child within seconds of noise (prevents self-settling)
• Inconsistent responses (sometimes intervening immediately, sometimes waiting)
• Treating normal sleep-cycle transitions as emergencies
• Maintaining sleep associations (feeding/rocking to sleep) whilst expecting independent night sleep
• Dream feeds after 16 weeks (disrupts natural consolidation)

See also: Sleep Associations, [[Sleep Training]], Night Terrors, Separation Anxiety, Reflux